Pediatric health blog by Dr. Nancy M. Silva. #WorkingMom, Small World Pediatrics #Doctor sharing my Best Pediatrician #parenting advice, #medical info, #affirmations, #quotes, #TampaBay, #Disney & other fun stuff too!
Thanksgiving Steps & Eating Photo by Element5Digital
Healthy Eating & Steps During Holidays are important during Thanksgiving. This is a time for eating and family, so it's important to be healthy on this holiday too! Many people are trying to have a healthier lifestyle. Then, Thanksgiving comes along and seems to ruin it all. Then, before you know it, you're making yet another New Year's resolution to lose weight. So how about starting your New Year's resolution early? And how about not focusing on weight loss? Rather, focus on your steps and healthy eating.
Tips on Staying Fit & Healthy Eating
Extra Steps & Healthy Eating is great to remember on Thanksgiving. Also, being thankful helps us to savor the food at a good pace. The slower you eat, the sooner you'll feel full. A Thanksgiving Affirmation will help you to remember how to be thankful on Thanksgiving.
Water helps your stomach feel full. In addition, sometimes we feel hungry, meanwhile we are actually thirsty. Our body will confuse thirst for hunger. In addition, holiday time can mean eating rich foods and drinking alcohol, all of which has lots of calories. Water helps flush out a lot of preservatives & sodium from our system. Remember to drink lots of water every day you indulge.
4 Ways to Squeeze in More Steps Over the Holidays:
Author Gretchen Rubin cites this as one trap that can send you into a cycle of negative thinking. In other words, if you slipped up or had a day where healthy eating wasn't the priority, then you may be hard on yourself. You may give yourself a harder time, ignoring all the good healthy steps and eating you have done. So, don't forget the good. Don't let a slip up erase all the good habits you have accomplished, formed, or develeoped. A slip up is just that, a slip up. It doesn't have to be a slide or downward spiral. In fact, the slip up may make you feel physically uncomfortable, thereby reminding you to go back to your good habits.
Ways to Add More Steps to Your Day
Set a Reminder to Walk – If you can add 15 min of walking during lunch & after work, then you’d be surprised at many extra steps you add into your week.
Walk & Talk – Make a phone call during your walk time. You’d be amazed at how quickly your walking time flies by, allowing you even to add extra steps too!
Walk & Listen – While walking, download a podcast, an audiobook, etc.
Walk Wherever You Can – Park the car farther away when you shop, pick up kids, run errands, etc.
Partner Up – Walk with a Walking Buddy.
Walk During Commercials – Walk around the room, the house, etc until the commercials are over. You will gain steps & not be a coach potato.
Make Things Inconvenient – Return the shopping cart to the store. Skip the drive-thru. Take the stairs.
Cook – Standing & moving around while cooking burns calories. Add steps in the kitchen while waiting for that water to boil, oven timer or the microwave timer to go off. You’ll save money by eating at home.
Clean – Even everyday household chores will add steps every time. And your home will be cleaner
Cooking Healthy Sides
There are many ways that sides can add a lot of calories. All the starches, all the butter, all the extra yummy pies - all add extra calories. Try these tasty sides that are each under 250 calories. They're a healthy and tasty alternative, especially if you're going for sceonds!
Coming out to you doctor may feel very scary and unsafe. Consider asking your doctor if their office is a safe office where acceptance is commonplace. Whenever the LGBTQ child is suffering, the most important thing I can say to them is, "You are safe. You are safe here." Because every child is special. After all, one of the best gifts a pediatrician can give to any child, especially the LGBTQ child/teen is letting them know they are special and wonderful just as they are. It is not my job to help the child/teen figure out their sexual orientation. It is my job to make them feel comfortable enough so that I can help them with any health issues they may have to date.
Come Out When You Are Ready
Coming out to your doctor can help you in many ways. However, given the difficulty that this may involve, you may want to consider calling your/any doctor's office first to ask if they care for any LGBTQ patients. Remember, you don't have to give your name out at the first call. Ultimately, this may help you feel more comfortable and ready.
How To Come Out To Your Doctor
There are many conversation starters you can use, such as "There's a conversation I need to have with you" or "How do you handle patient confidentiality?" Consider telling the doctor in a matter-of-fact way. Chances are, you are not the first LGBTQ patient they have ever had. Follow up with a prepared list of questions that you have for your appointment. There is a "Do Ask, Do Tell" brochure that may help answer questions about coming out to your doctor. It is also important to know that there are laws that protect you and your doctor, so that your information is kept private. Ask about confidentiality will make you feel safe as well. In addition, you may consider bringing a friend, partner, or family member for support.
Doctors Can Offer Support in Many Ways
I've had teens come out to me as their doctor, some have been painful to witness. Painful for me, because it incredibly hard to see someone suffer and be in such tremendous emotional turmoil and/or physical pain) for simply saying their sexual orientation and/or gender identity. In the past, I reassured a transgender child in the midst of an immediate, intense, and severe panic attack by continually repeating, "You are safe. It's okay. You are safe here. You don't have to talk about it, but if you do, I'm here for you." I have had patients who became successful adults with great careers who thanked me for accepting them because I was the first person they came out to or that I cared for them and their issues with compassion and maybe even some tough love. Most recently, I held and rocked a child that I cared for over 15 years until they stopped their uncontrollable shaking because they couldn't face themselves and their sexual orientation. That child motivated me to write this blog. I want to help other LGBTQ youths know that they don't have to suffer, that their doctor can help them. Chances are your doctor cares and wants to help you in your journey to physical and mental health and peace.
A doctor will also be able to make some psychological recommendations, if needed. LGBTQ teens are more likely to suffer from anxiety, depression, have increased risk of suicide, abuse, may need referral to a psychologist, a psychiatrist, and/or a support group, like the Gay Straight Alliance (GSA), and GSA Network. GSA is a student-led or community based organization. GSA is an important resource on social media on Twitter (@GLSEN) and Facebook. GSA Network is also a resource available on Twitter (@GSANetwork) and Facebook. Local support groups area usual available for GSA and GSA Network on social media and in as clubs many schools. Lastly, your doctor is a source of support, simply be accepting you and caring for you.
Doctors Willing to Learn LGBTQ Issues & Needs
Your doctor may be comfortable with caring for you as a LGBTQ patient. However, we are not classically trained to care for LGBTQ patients, so there usually is a learning curve. However, if your doctor says, "I don't know how to care for that issue, but let me do my research; I'll get back with you on that particular issue," then you have a great doctor indeed. A doctor that's willing to learn, cares for you, and is honest is the best kind of doctor.
Yes! There are many test anxiety strategies on how to deal with test anxiety. First, I'm going to review the causes, the symptoms, and who gets it before I discuss what test anxiety strategies to use for managing test anxiety.
What is Test Anxiety?
Test anxiety is a feeling someone gets before or during test taking. It is a type of performance anxiety, that occurs when someone is typically concerned about getting a good outcome. The result is physical and psychological symptoms that occur before or during tests. Test anxiety can negatively affect learning and performance. The good news is there are test anxiety strategies on how to deal with it.
What Causes Test Anxiety?
It is caused by fear of failure, poor test preparation and/or problematic test taking history. There is pressure to perform at your best level. This can motivate the test taker. However, it may also create fear of failure. Good test preparation is important for a good test result. It is also important to prevent test anxiety. A calm test taker tends to know they've studied to the best of their ability. They also tend to have studied over time, and not in just a few days or at the last-minute. If the test taker has had a history of negative experiences with test or poor grades on test, this can also cause anxiety on future tests.
What Are Symptoms of Test Anxiety?
Symptoms are physical, emotional, and/or behavioral. They range from mild or very intense.
The physical symptoms may include: headache, nausea, vomiting, diarrhea, fast heart rate, fast breathing rate, feeling like you can't breathe. If the anxiety is severe enough, a panic attack may occur. When someone is having a panic attack, it is generally very debilitating. A panic attack can make a person feel paralyzed internally or externally, like they can't move, can't talk, & they may feel like they're having a heart attack.
The emotional symptoms may include crying, feeling fear, feeling sadness, and helpless.
The behavioral symptoms may include negative self talk, inability to think clearly, and inability to function.
Who Gets Test Taking Anxiety?
Worriers - If your child has a tendency to worry, he/she is more likely to suffer from test anxiety. Even if your child is prepared, your child's worrying could cause test taking anxiety.
Perfectionists - If your child aims for self perfection, then he/she is more likely to suffer from test anxiety. Even if your child does wll in school, the very thought of getting questions wrong, or getting less than an A, leads the perfectionist to have test taking anxiety.
Unprepared People - If your child has not learned the subject matter, not practiced with classwork/homework, and/or studied the material, then he/she is more likely to suffer from test anxiety.
Ask your child what's making your child feel nervous.
Talking about their feelings make children have less anxiety. Stay calm too as this helps your child stay calm as well
This can be a part of you child's life lessons. Teaching your child to handle things when the outcome is not what they expected will help them in life, not just in test taking.
Boost your child's confidence.
Tell them how wonderful they are. Ask them to give themselves compliments. What do they like about themselves? About their great brains?
Always offer support.
Remind your child that you are always there. Sometimes, they don't want a solution. Sometimes being a listener is all he/she needs.
Review Studying Habits & Test Prep
Have your child practice on sample tests.
Having experience with what the test will feel like will prevent anxiety.
Focus on test preparation.
Establish a routine for studying and preparing for the upcoming test is very helpful. Studying a little bit at a time, over a set time period. It is usually better than craming it in the day before the test. It also also for better retention of the facts.
Learn your child's best study habits.
When does he/she study best? Is it morning, afternoon, or night?
Does he/she need breaks?
Could hunger be slowing his/her learning/studying? Consider snack breaks in between studying.
Does he/she need to do something physical or move around in between studying.
Review test taking strategies.
Teach your child what to do if they are stuck on a test question. If they can't answer one, then teach them to mark the question and move on. They can get back to it later.
Help your child feel their best the day of an exam
Review all methods and test after the test is complete.
What were your child's strengths on the test? Where are their weaknesses? How could he/she have improved test prep? What did he/she do that was just right? What can he/she do again the next time? Or do differently? Ask them to evaluate this with you.
Sleep & Screen Time
Find your child's best number of sleep hours.
Does your child need eight (8) hours a night? Ten (10)? Twelve (12)? Try to make sure they get their best sleep before tests.
Monitor your child's screen time.
If your child has too much screen time, especially at night, or the days or week before an important test can do more harm than good.
Relaxation, Guided Meditation & Affirmations
Practice relaxation techniques.
Taking a bath
Listening to relaxing music
Create art. Drawing and/or coloring is fun and relaxing.
Play a board game that's fun with the family the day before the exam.
Watch a funny movie with your child. Sometimes, laughter is the best medicine.
Use Guided Meditation.
I recommend and use, I Am Peace, by Susan Verde. This is a wonderful book. It is geared for children. I think it's a great book for any age. The last page has a Guided Meditation. I've read this out loud to my son while he is lying down with his eyes closed. I must say that both he and I are relaxed at the end, every time.
E-cigarette cancer chemicals have increased in teens. Before we get into the details, let's review the background of E-cigarettes. E-cigs are electronic cigarettes that have liquids that contain many chemicals including nicotine, and fruity and other flavors. They are battery-powered and mimic cigarettes, but don't have the smell of smoke. The liquid changes into a vapor due to the heat in an e-cig. Hence, it’s also called “vaping.”
What is Juuling?
There is a new teen trend called “Juuling.” Juuling is an e-cig that is thin, looks like a flash drive, and charge in a USB port. A juul produces less smoke which disappears more quickly. Hence, teens are able to juul at school and home without parents’ knowledge. In comparison to smoking cigarettes, one juul pod (cartridge) has as much nicotine as a pack of cigarettes.
Caffeine sensitivity - they decrease their caffeine intake.
Higher rates of pneumonia
E-Cigarette Cancer Causing Chemicals
Juul Looks Like a Flashdrive
They’ve been advertised as a safe alternative to cigarettes. They’ve also been advertised as an aid to stopping smoking. Since e-cigs don't burn tobacco, they don't burn the same amounts of tar ans carbon monoxide. However, e-cigarettes are unsafe, contain high levels of nicotine, and do not help in smoking cessation. E-cigs and juuls have many cancer-causing chemicals (acrylonitrile, acrolein, acrylamide, benzene and ethylene and propylene oxide, and crotonaldehyde).
Study Showed E-Cigarette Cancer Chemicals Increased in Teens
In a recent study of 100 teens from the San Francisco Bay area by the University of California-San Francisco study: 67 teens used e-cigs only, 16 used both e-cigs and conventional cigs and 20 didn't smoke or vape at all. Urine and salivary gland fluids tested positive for cancer-causing chemicals in teen smokers. It revealed that teens who used e-cigs and cigarettes had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that used only e-cigs. It revealed that the teens that used e-cigs only had three (3) times higher amounts of these e-cigarette cancer causing chemicals in their body fluids as compared to the teens that didn't smoke at all. Lastly, the study also showed that teens who used fruit-flavored e-cigarettes had significantly elevated levels of acrylonitrile as compared with those who used other flavors, such as menthol.
The American Academy of Pediatrics (AAP) and its Maryland chapter, the Campaign for Tobacco-Free Kids, four other public health groups and five pediatricians filed a lawsuit against the FDA for delaying submission product-review applications for cigars and e-cigarettes until August 2021 and August 2022, respectively. This leaves children at increased risk of cancer and other negative side effects from e-cigs.
Learn & Talk About the Risks of E-Cigarettes with Your Kids
America had a truly historical moment on Saturday, March 24, 2018. The March For Our Lives was led by the student survivors of Marjory Stoneman Douglas High School, Parkland, FL. There were 800,000 teens and adults who attended the March in Washington, DC. Many more attended in cities across the U.S. to demand change in gun laws and talk about gun violence in America.
Gun Violence in America
A March led by our minors is amazing. Even more amazing is that they included all others affected by gun violence in America, including domestic gun violence victims, police gun violence victims, and more. This was not just a march to stop school shootings and school violence. They made a statement that "Enough is Enough".
They were also incredibly articulate. In an era when so many think children are just children, it was wonderful to see them show the world that our American children can stand up for themselves, provide valuable statistics to support their positions, and be able to address our Congressional leaders with words and action. They are stating that when they are eligible to vote, that they will vote based on this sole cause. Many don't believe they will follow through on their actions. However, many don't realize that once your voice has been heard, you are a force to be reckoned with always.
Students Speak Up
Several students stood out. Emma Gonzalez spoke and stood in silence for about 6.5 minutes to honor to victims of the Marjory Douglas High School shooting on February 14, 2018. This was less than the duration of the school's shooting. It was symbolic of the time that students and teachers died, were injured, and were hiding in fear. The silence was deafening and powerful.
Samantha Fuentes, another Parkland school shooting survivor with gun wounds on both legs and shrapnel on her face stood up for herself and her friend, Nicholas Dworet, who died and would've turned 18 years old on the day of the march. Overcome with emotion, she vomited behind the podium and persevered with her speech and led the crowd in a Happy Birthday song to her beloved dead friend. She was courageous and empowered. David Hogg, another survivor stated, "The people in power are shaking." The most popular chant at the march was "Vote Them Out."
The students have detailed explanations in their "Manifesto to Fix America's Gun Laws," as listed in their words, in their guest editorial in the Guardian. These are the nine (9) gun law changes they request, as written by the editorial staff students of the Marjory Stoneman Douglas newspaper, the Eagle Eye:
Ban on semi-automatic weapons that fire high-velocity rounds
Ban accessories that simulate automatic weapons (e.g. bump stocks)
Establish a database for gun sales and universal background checks
Change privacy laws to allow mental healthcare providers to communicate with law enforcement
Close the gun show loophole and loophole for second-hand gun sales
Allow the CDC to make recommendations for gun reform
Raise the firearm purchase age to 21
Dedicate more funds to mental health research and professionals
Increase funding for school security
Democracy at Work
This march shows how a democracy works. It shows that everyone can use their voice. It has empowered many of our youth for the future. The future is in our children. Wait and watch because gun violence is only the beginning for these children, these future lawmakers, these activists; their future has so much more ahead!
As of the end of December 2017, the flu season is officially moderately severe. The flu is widespread in 46 states. This is up from 36 states in the previous week. The U.S Centers for Disease Control and Prevention (CDC) research reveals that flu hospitalization is about 3 times higher than it was in the same time period in 2016. In addition, the flu season started earlier this year than it did in 2016. During the same time period in 2016, only 12 states had reported widespread activity, as compared to 46 states this flu season. This pretty much matches what I’ve been seeing in our office in Florida. About 3 weeks ago, we began to diagnose multiple children with the flu every day.
Why is this Flu Season Severe?
This season’s dominate flu strain is an Influenza A strain, H3N2, which is a particularly severe and causes more symptoms than other strains typically do.
What Are Flu Symptoms?
Flu symptoms typically include a fever and nasal congestion at a minimum. Other symptoms may include weakness, nausea, vomiting, diarrhea, headache, body aches, and more.
What To Do If I Think I Have the Flu?
If you are feeling sick with flu-like symptoms, you may want to consider going to see a doctor, especially within the first 48 hours of your illness. Your doctor may be able to prescribe an anti-viral medication against the flu, Tamiflu, which is effective in preventing worsening symptoms of the flu by stopping its replication. However, if you’ve been sick with the flu for more than 48 hours, Tamiflu is not effective.
I Have the Flu. Now What?
Follow your doctor’s instructions. Drink plenty of fluids. Rest. Stay home. Do not go to work, school, religious gatherings, or other community gatherings or events. By going out, you increase the risk of spreading the flu. In addition, as the flu weakens the immune system, if you go out, you place yourself at risk for contracting a secondary bacterial infection, such as pneumonia, sinusitis, or an ear infection.
The good news is that the CDC reports that this season’s flu vaccine strains are a good match to the live flu virus strains that are circulating (http://bit.ly/2CLWaCZ). That means the flu vaccine is providing good protection against the flu by preventing the flu so far.
The best course of action is to make sure you and your children get the flu vaccine. It’s not too late. No one knows exactly when the flu season ends. From the looks of it, it will probably continue for another few months. There is still time to protect yourself. Get the flu vaccine at your doctor’s office, health department, school, or pharmacy today.
A 9 month old infant girl from Connecticut was found to have lead poisoning. Doctors discovered that the young infant had a high lead level during her routine physical exam.
According to a report (http://bit.ly/2wBf8LJ) by the Centers for Disease Control & Prevention (CDC) on August 31, 2017, her blood lead level of 41 micrograms per deciliter of lead was much higher than acceptable. According to CDC, an acceptable blood level is up to 5 micrograms per deciliter.
Investigators reviewed the home in detail. Although there was lead paint on two of the windows in the home, the infant girl was not able to reach those windows, so she couldn't have contracted lead poisoning from them. In addition, the her 3-year-old and 5-year-old siblings didn't have lead poisoning, so the windows were not the source of the lead.
The baby girl's parents bought her a homeopathic magnetic bracelet to help with teething pain. She had used the bracelet for teething relief, chewing on it, causing her to ingest the lead. The homeopathic community believes magnets help with healing. Tests on the beads of the bracelet revealed that it contained 17,000 parts per million (ppm). According to the U.S. Consumer Product Safety Commission (CPSC), for the most part, products containing 90 to 100 ppm are considered safe.
Chewing & Lead Poisoning
Please be careful with items that your child may chew on. Sadly, each year, there are recalls on children's jewelry due to high levels of lead and cadmium poisoning (https://drsilvatotstweensandteens.com/2010/02/cadmium-jewelry-poisoning.html). Infants and toddlers place objects in their mouths as part of their development and natural curiosity. They learn about their world orally, in this fashion. Depending upon the lead level in a child's body, lead poisoning has long-term consequences including, but not limited to lower IQ, speech delay, behavior problems, seizures, and death. Treatment does not necessarily reverse the negative effects of lead on the brain and body.
Routine Physical Exam & Lead Testing
Please remember to follow-up with your pediatrician for your child's physical exam, as so much is done at these visits, including lead level testing, if recommended. Consider buying a lead surface test kit for your children's toys or objects they may place in their mouths, as lead poisoning is a nightmare for any family to handle whether from teething bracelet or toys.